Introduction: The Strength and BALance (SABAL) program targets reduction of fall risk in older adults through fun, meaningful, and motivating games that incorporate evidence-based exercises and automatic generation of fall risk metrics. The product, consisting of virtual world-based gaming software and an off-the-shelf KinectTM sensor, will be used in senior centers, retirement communities, skilled nursing facilities, rehabilitation clinics, and private residences to promote adoption and adherence to an exercise program. Key innovations include: (1) integration of evidence-based strength and balance exercises into an immersive gaming experience; and (2) automated feedback to users and care-providers through advanced human motion tracking. Focus groups involving seniors in multiple settings will inform game design and explore older adult attitudes towards elements of social interaction, competition, and online community. Phase I human participant testing will establish the criterion validity of game-generated fall risk metrics. The aggressive Phase I plan is undergirded by a multi-disciplinary team that was recently awarded a 2013 Brandon Hall Award for Best Use of Games for Learning for development of game-based interventions for at-risk populations. Problem to be addressed: SABAL addresses the critical challenges of: (1) reducing risk of falls in older adults; (2) reducing resulting costs of treatment and hospitalization; (3) encouraging adherence to an evidence- based exercise regime; and (4) extending access to health services in remote/underserved areas. Long-Term Goal: Reduced rate of falls and number of people falling in the population of older adults. Phase I Summary: The Phase I STTR effort employs user-centered design to emphasize the experience of older adult users and their care providers. Focus groups, conducted at a local assisted living facility and a regional wellness center, will support identification of game themes, activities, and modes of social interaction that are most likely to motivate adherence. The results will guide the Phase I development of games that integrate evidence-based interventions, automated assessment, and employ state-of-the art graphics, audio, and user interactions. Researchers at the University of Virginia will lead a pilot study, employing the Phase I prototype to: (1) quantify correlation between SABAL game-derived metrics and clinically-accepted measures of fall risk; and (2) assess system usability/likelihood of use by older adults through interviews and responses to Likert-scale questionnaire based on the Technology Acceptance Model (TAM) and System Usability Scale (SUS). Subsequent Phase II research will include development of a web-enabled SABAL commercial product; human participant studies to establish efficacy of virtual worlds-based gaming for fall risk reduction; and study of the potential benefits of games for adoption and adherence in home, skilled care, and community settings. Commercial Opportunity: SABAL software will be available to institutions via a Perpetual License or as a Software-as-a-Service (SaaS) subscription. Individual user licenses will be available at a discounted rate.